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03090134 (2) CITY OF CUPERTINs BUILDING DIVISION PPR14 CONTRA.CTO-R INFIJ'Rr1V BuaDINCADDRESS: CELEBRITY WINDOWS & DOORS fM4 "'03090134 'R'S NAME: 1087 FLORENCE WAY PERMIT ISSUE DATE E: (408) 266-6500 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER; BUILDING PERMIT INFO BLDG ELELT PLUMB MECH 0 0 0 0 +oo LICENSED CONTRACTOR'S DECLARATION C I hereby affirm that 1 am licensed underderp provisions or Chapter 9(commencing Job Description b with Scolio. ndeffec Division Sarum Business and Professions Cole.end my license is ' w in full force ontl effect. ipl�z License Clan Lu.N WINDOW REPLACEMENT (8) a t-❑ Dale Contractor N e g 5 ARCHITECTS DECLARATION t i U 1 understand my plans shall he used as public records /O�/ 'Qy Licensed Pro � Fissional www C S OWNER-BUILDER DECLARATION V <f 1 hereby affirm that 1 am exempt tram the Contractor's License Law fur the 3 po following reason.section 7031.5,Business and Professions Code:Any city or county 5 which acquires a Permit to construct,alter,improve,demolish,or repair any structure priono its issuance.also requtacs the applicant for such Permit to file asigned sentiment < nhafhc is licensed pursuant to the provisions of the Contractor's License Dow(Chapter 9 Sq. Ft. Floor Area Valuation e~ (commencing with Section 7000)of Division 3 or the Business and Professions Code)or ERE$ Nm at he is exempt d crcfroand the basis for the alleged exemption.Any vinlmian of 3 6917008 . 00 Section 7031.5 by any applicant for permit objects the aoplicam to a Civil pcnalty'of anC APN Number Occupancy Type . nnlmoretlam five hundred dollars(55W). - "-' - -" - - - P Y ---- - ❑1,es owner of the properly.or my employees with wages m Ncir sole compensation, will do Ne work.and the smuctuac ianat intended oroliercd for sale(Site70,14,Business iUi - and Professions Code:The Contractor's License Law does not apply to an owner of 102 - PIERS d Inspections es property who builds or improves Neon,and who does such work himself or through his awn employees,provided that such improvement;as,not intended or offered formle.If, 103 _ UFER . however,are building or improvement is sold within one year orcomPletion,the owner- builder will have are burden of proving that he did not build or improve for purpose of 104 - REBAR e')' - 105 - ANCHOR BOLTS 1,as owner of to property,am exclusively contracting wain licensed contractors m A - --- . struct the project(Sea.7(1a4,Business and Professions Code:)The Contractor's Li- 106 - SEWER & WATER Comm Law does not apply to an owner of property who builds or improves Neeson,and 202 - UNDERFLOOR PLUMBING who contracts for strep projects with a contract (s)licensed pursuanuo the Contractors Liaon,oLaw 203 - UNDERFLOOR MECHANICAL IF1m exempt under Sec. ,B&P C forNia caa n / Dal 204 - UNDERFLOOR FRAME R ER'SCOM ATIONDECLARATIO 205 '- "UNDERFLOOR .INSULATION' I hereby affirm under penalty of perjury one of the following declarations: 301 - ROUGH PLUMBING and will maintain aCertieemeofConsent toselrnsaesfor Workerxcompen- 302 - TUB & OR SHOWER as provided for by Section 3700 of Ne Labor Code,for Ne performance of the 303 - _ROUGH- MECHANICAL ar which this permtt is issued ave and willmaintain Worker's Compensation Insurance,as required by Section 3 0 4 — ROUGH ELECTRICAL 3700 of the labor Code,for the performance of Ne work for which this permit is issued. 305 - FRAME My Worker's Compensation Insurance carrier and Policy number am: 306 - HOLDOWNS Cartier: Pol icy No.: _ CERTIFICATE OF EX EM MON FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK . (Thisuction need nothecompleted tithe lerdthisforonchundrcUdallaranlq)) 309 - EXTERIOR LATH or less.) I Unity that in the performance of the work for which this permit is issued,l shall not 310 - INTERIOR LATH employ any person in any manner o as w hccomc subject o the Workers'Compensation 311 - SCRATCH COAT LawsApplicant ppplic^California:Dem 313 - ROOF NAIL NOTICE TO APPLICANT.If,aper making this Ccnificale,of Exam prion,you than ld 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Cam pcnsatinn provisions of the Labor Code,you must ,z forthwith comply with such provisions of this permit shall be deemed ranked. 502 — FINAL PLUMBING ENERGY 75 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY "' Ihereby affirm that there tcacomucttnnlendin 504 - FINAL BUILDING ENERGY g agency for the performance of ~Y.> Nc workrwhichnhiapertnitisissucd(Sec.J(197,Civ.C.1 505 - FINAL ELECTRICAL 1]Q Lendder'sC,'sName jz LcndersAddress 506 - GAS TEST J O 1 Certify Nan 1 have read this applicmton and sort Net Nc above immmniun ix 507 - FINAL PLUMBING correct.l agree to comply with all tiny and County oNinencet Mi and state laws sting to Vbuilding comarection,and hereby maintainrepresentatives ofNisCity tocaterupnnNe FIN MEC( CAL U above-mention n!property for inspection purposes. (We)agree to save,indemnify and keep harmless the City o(Cupcnino against 0 9 FI h Iiabilities,judgmenta,costs and expenses which may in any way summit against mid Ciny 5 I NG J 7 in conuyucncc of a granting of obis omit. •7 APPLICANT IJ DERSTANDS WILL COMPLY WI LL NON-POINT Issued by:5 C WORKS Date S CEREp11 ATIONS. �y�`� r /,1, 1JL. X YAlflIn 5�1Y/03 Re-roofs gnat ofA pbcaH HAZARDOUS MATERIALS DISCLOSURE Type Of Roof ill Ne applicant m future building occupant tome or handle have dous material fined by the Cupenino cipal Coda,Chapter 9.12,and the Health and Safety Section 25532(,1)? All roofs shall be inspected prior to any roofing material bei ge installed. Yon Nu Will me applicant nr ti m building amtapam a tgaipmtm or ammmtt which If a roof is installed without first obtaining an inspection,I agree to remove mondnus air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection. in? ❑Yes No Ia&SdeJ Nchmsr us mamrials acyuircmcnss under Chepmr6.95ofplc Califao- uta Hcaacromo c ode,Secdat¢3550 is,my3sponsi ilium mJodfyt NentfdmhufW g dos not curtc haxx a mnant.Na is y responsihility to nntily lite r eupant of Nc our ircnc Ch must be men ata is ante ora ccmncar Laic% 3 Signature of Applicant Date /� r1 Canada,aunhori].cJ agentg All roof coverings to be Class "B"or better asp c, ITY OF CUPERTINO* cUCITYOF o PERMIT APPLICATION FORM PEkTN# r Date: y„ Building Address: (9415 N1 r+le..w��� �Jrw� Owner's Name: Phone #: D0,a.e.1 E. fLOs--- cane Sus�� Gruber �CQS- Ilz Contractor: License#: C-6p-,10rvwl x7a771-135 Contact: Cupertino Business License#: "O,rK Rome � X00 e ' 9 .30 Building Permit Info: v 114 'Bldg 03 Elect ❑ Plumb ❑ Mech ❑ Job Description- ��CY L q (� W1o0,5 Residential C n o cnrnunI ommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: / asa Cost of Project: Occupancy Gro p: O e of Construe •on • Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING z 3/ k3 1 of 3 f rl S I *ITY OF CUPERTINO* CUP TYOF NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMlvT New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINfERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check R eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • 2 of 3 OITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN. Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ' Special hispection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL i BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE I Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING ' 1 • 3 of 3 �■ 'chi ■■■ ■ ' 1 t 1 i ' . . .�!"��-�.. , . .CJS ■